Pain and fever medications are drugs given to children that help provide relief from these symptoms. These medications are safe and effective when parents give them to children as directed by a physician.  

Medications used to block pain are commonly known as analgesics. They either stop pain signals from going to the brain or alter the brain’s interpretation of those signals. Medications that are used to treat fevers are typically known as antipyretic agents. They do this by blocking the mechanisms that cause fever.

Minor episodes of fever or pain often do not require any treatment. However, in some cases a child’s discomfort can be substantial enough to require medical treatment. Acetaminophen and ibuprofen are two of the most commonly recommended combination fever reducers and pain relievers suggested for treating children.

Aspirin is one popular analgesic that should never be used in children. Though aspirin can be a powerful and effective drug, it also can be dangerous when used in children. Use of aspirin in children has been associated with Reye syndrome, a rare but extremely serious condition that affects all organs of the body and that can be fatal.

Fever-reducers and pain relievers may be used to treat many different conditions in children, including fever, back pain, headaches and more serious disorders. Patients, or parents and other caregivers of patients, should inform physicians of any allergies or medical conditions that they have, as some may preclude the use of certain pain and fever medications. Patients are also urged to disclose information about drugs they are taking to their physician, as some medications interact poorly with other medications.

Various medications are available that offer relief to children who display symptoms of pain or fever. In many cases, a single drug can both provide relief from pain and reduce fever. When used correctly, these drugs are safe and cause few side effects in children.

Medications used to block pain are commonly known as analgesics. They either stop pain signals from going to the brain or alter the brain’s interpretation of those signals. In both cases, analgesics prevent the brain from processing pain signals, yet do not rely on anesthesia or loss of consciousness to achieve their pain-relieving effect.

There are two primary types of analgesics:

• Non-narcotic analgesics. Also known as non-opioids, they are milder forms of the painkillers that include acetaminophen, the most commonly used over-the-counter non-narcotic analgesic. Other drugs are not technically part of the analgesic family, but are nonetheless considered analgesics in practice. These include nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen.
  
  
• Narcotic analgesics. Also known as opioids, they are stronger analgesics that are used when pain signals are too severe to be controlled by non-narcotic analgesics. Examples include morphine and codeine.

Medications that are used to treat fevers are typically known as antipyretic agents. They work by blocking the mechanisms in the body that cause fever, but do not treat the underlying condition that causes the fever. The most common antipyretics are acetaminophen, ibuprofen and aspirin. The last of these should never be used to treat children, as aspirin can cause Reye syndrome, a rare but extremely serious condition that affects all organs of the body and can be life-threatening.

Children who have mild fevers (102 degrees Fahrenheit or less, or 39 degrees Celsius or less) may not require treatment of any kind. The exception is in infants under two months of age, when medical treatment should be sought if the child has a fever over 100.4 degrees Fahrenheit (38 degrees Celsius). If the child is drinking plenty of fluids and behaving normally, it may be advisable to simply let the fever run its course. However, there are many times when a fever-reducer can relieve a child’s discomfort. Drugs such as acetaminophen and ibuprofen may be used if children are achy or irritable, or if they complain of headaches or other similar symptoms.

Pain relievers should also be used sparingly. Minor bumps and bangs may not require any medication. However, if the child complains of tenderness or has symptoms associated with inflammation, a pain reliever may help reduce the child’s pain.

Acetaminophen and ibuprofen are two of the most commonly recommended combination fever reducers and pain relievers suggested for treating children. These drugs have few side effects and are even considered safe for infants, who may take them in drop form. Liquids are available for toddlers, whereas chewable tablets may be preferred by older children.

These medications should only be given as recommended by a physician. The size of the patient and severity of the illness are usually the most important factors in determining dosage levels. However, most medications typically describe appropriate dosage levels according to the patient’s age. These guidelines work well in most cases.

Parents are urged not to deviate from the recommendations suggested by a physician or a drug manufacturer. For example, it is inappropriate to give a toddler multiple doses of a “drop” medication recommended for infants, as these formulations are highly concentrated and may have adverse effects when used differently than recommended.

There are numerous types of medications that can be used to reduce a child’s fever or level of pain. Just as with prescription medications, over-the-counter medications are strong drugs and should only be used as recommended. Parents and other caregivers should not give any drug to a child without first consulting a pediatrician or other healthcare professional. This is particularly true of children who are 2 years old or younger.

Some of the more popular medications used to control a child’s pain or fever include:

• Acetaminophen. Used to treat mild-to-moderate pain and fever in children. Because acetaminophen has few anti-inflammatory properties, it is not the best drug for treating inflammatory disorders caused by infections and many types of injuries. In such situations, ibuprofen may be a better alternative.
  
  Dosage is generally dependent on a child’s weight. Special attention must be paid to making sure children get the appropriate dosage of the drug, as acetaminophen overdose – which can be toxic to the liver – is among the most common causes of drug-related deaths in children and adolescents. For this reason, acetaminophen should not be given to children without first consulting a physician. Children should not take acetaminophen for more than five days.
  
  
• Ibuprofen. A pain reliever that also reduces inflammation and fever. Ibuprofen is a type of nonsteroidal anti-inflammatory drug (NSAID) and is used to treat numerous types of pain, including headaches, muscle aches and many other causes of discomfort. A recent Canadian study found that ibuprofen provided better and more efficient pain relief than acetaminophen or codeine for children with acute musculoskeletal injuries. It also is typically considered to be particularly effective for treating high fevers. This drug should not be given to infants younger than 6 months old. In addition, ibuprofen should not be given to children who are dehydrated or who are vomiting repeatedly.
  
  In 2005, the Food and Drug Administration (FDA) announced that it was asking all manufacturers of prescription NSAIDs – including ibuprofen – to include new warnings on labels about certain potential health dangers associated with these medications, such as an increased risk of cardiovascular events and gastrointestinal bleeding that could be potentially life-threatening.
  
  
• Other analgesics. Many analgesics have not been established to be safe when used in children. In other cases, these drugs are considered safe for children of certain age groups. For example, naproxen and ketoprofen are not generally recommended for children under the age of 12.

Aspirin is one popular analgesic that should never be used in children. Derived from salicylate – a naturally occurring substance found in the bark of willow trees – aspirin has been used for more than 100 years to relieve mild-to-moderate pain and to reduce inflammation, fever, redness, swelling and discomfort caused by various medical disorders. It also helps reduce clotting of blood.

Though aspirin can be a powerful and effective drug, it also can be dangerous when used in children. Use of aspirin in children has been associated with Reye syndrome, a rare but extremely serious condition that affects all organs of the body and can be fatal. The danger is most present in children who take aspirin when they have a viral infection, the flu or chickenpox. Symptoms include vomiting, lethargy and behavioral changes (such as increased belligerence).

As a result of this danger, experts recommend that aspirin not be used by anyone under the age of 21, especially if they have a viral illness. In addition, children may be more vulnerable to the side effects of aspirin than adults.

Fever-reducers and pain relievers may be used to treat many different conditions in children, including:

• Fever
  
  
• Pain
  
  
• Teething
  
  
• Earaches
  
  
• Headaches
  
  
• Arthritis (including juvenile rheumatoid arthritis and other joint-related pain)
  
  
• Sore throat
  
  
• Fibromyalgia (a disorder characterized by muscle and joint pain)
  
  
• Muscle aches

Patients, or parents and caregivers of patients, should inform physicians of any allergies or medical conditions that they have, as some may preclude the use of certain pain and fever medications. These conditions include:

• Anemia (red blood cell deficiency)
• Asthma, allergies and history of nasal polyps
• Brain disease or head injury
• Colitis (intestinal inflammation)
• Emotional problems or mental illness
• Emphysema or other chronic lung disease
• Heart disease
• Hemophilia or other bleeding problems
• History of alcohol and/or other drug abuse
• History of convulsions (seizures)
• Kidney disease
• Liver disease
• Overactive or underactive thyroid
• Stomach ulcer or other stomach problems
• Vitamin K deficiency
• Diabetes or other endocrine disorders
• Hodgkin’s disease (rare type of cancer)

Some children may experience upset stomach when taking certain pain and fever medications. To avoid this side effect, children should take these medicines in a physician-approved manner. In many cases, this involves taking the medication with meals, or a full glass of water or milk. Some drugs such as acetaminophen are generally gentler on the stomach than others.

Side effects associated with certain analgesics (pain relievers) and antipyretics (fever reducers) – especially when they are taken in large doses – include:

• Drowsiness
• Dizziness or lightheadedness
• Nausea and vomiting
• Dry mouth
• Constipation

Acetaminophen and ibuprofen are usually safe in children when taken correctly. However, long-term uses of acetaminophen or overdose of the drug can cause liver failure. Ibuprofen can cause a number of side effects, including indigestion (dyspepsia), gastrointestinal bleeding and reduced renal (kidney) blood flow.

Other analgesics may also present specific risks when used by children. For example, children under age 2 who take naproxen have an increased risk of developing a skin rash when using this drug. Parents should not give their child any analgesic until they have discussed the potential side effects with a physician, preferably a pediatrician.

Patients, or parents and caregivers of patients, should consult physicians before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications.

Parents should not give more than one fever reducer or pain reliever to their child at one time unless a physician directs them to do so. In addition, parents are urged to carefully check the ingredients of other medications. For example, some cold remedies may contain a pain reliever or fever reducer, such as acetaminophen, in the ingredients.

Before using analgesics (pain relievers) or antipyretics (fever reducers), patients should inform their physician if they have ever had an allergic reaction to any type of analgesic, including acetaminophen, aspirin or other salicylates (e.g., methylsalicylate). Parents should also tell their child’s physician if the child has ever had a reaction to any other medications.

Medications that can impact treatment with analgesics or antipyretics include:

Patients should also report any allergies to other substances such as foods, preservatives or dyes. Alcohol and other CNS depressants should not be used with pain and fever medications. Examples of CNS depressants include:

• Anesthetics
• Antihistamines or other allergy medications
• Antiseizure medications
• Cold medications
• Muscle relaxants
• Any prescription pain medication
• Sedatives, tranquilizers or sleeping pills

Other medications, or substances, that may adversely interact with analgesics or antipyretics include:

• Caffeine
• Phenothiazine (antipsychotic)
• Rifampin (tuberculosis medicine)
• Vitamin supplements
• Watercress

Symptoms of overdose can be similar to the medication’s side effects, but are usually more severe. Parents of patients exhibiting any of these symptoms should contact their child’s physician immediately:

• Cold, clammy skin
• Confusion
• Convulsions (seizures)
• Delirium
• Hearing loss
• Irregular heartbeat
• Jaundice
• Low blood pressure (hypotension)
• Ringing or buzzing in the ears
• Severe anxiety, nervousness or restlessness
• Severe dizziness
• Severe drowsiness
• Severe weakness
• Shock
• Shortness of breath or breathing problems
• Vomiting

Preparing questions in advance can help patients and parents have more meaningful discussions with their physicians regarding their or their child’s treatment options. The following questions related to pain and fever medications may be helpful:

1. How will I know if my child’s pain or fever requires drug treatment?
   
   
2. Which pain relievers or fever reducers are best for my child’s needs?
   
   
3. Are certain medications better at treating fever?
   
   
4. Are certain medications better at relieving pain?
   
   
5. Which medical conditions might prevent the use of these medications in my child?
   
   
6. Is there any instance where aspirin might be the drug of choice, despite its risks?
   
   
7. How many times a day should my child take these medications?
   
   
8. Which side effects should I look for when my child uses a fever reducer or pain reliever?
   
   
9. When should I contact you about side effects in my child?
   
   
10. What are the symptoms of potential overdose that I should watch for in my child?
    
    
11. What other treatments might best supplement my child’s medication therapy?
    
    
12. For how long will my child need to take these medications?
    
    
13. What should I do if the medications do not appear to be working?